0524: Efficacy of Certolizumab Pegol in Preventing Anterior Uveitis Flares Compared with Standard Non-Biologic Treatment: A Matched Control Study in High-Risk Patients with Axial Spondyloarthritis

Nigil Haroon¹, Zeynep Baskurt², Tina Chim³, Robert Inman⁴, Diana Paez⁵, Thomas Kumke⁶, Rachel Tham⁷, Mindy Kim⁸, Irene van der Horst-Bruinsma⁹ and Lianne Gensler¹⁰, ¹University of Toronto, University Health Network, Schroeder Arthritis Institute, Department of Medicine/Rheumatology, Toronto, ON, Canada, ²Department of Biostatistics, University Health Network, Toronto, ON, Canada, ³University Health Network, Schroeder Arthritis Institute, Department of Rheumatology, Toronto, ON, Canada, ⁴University Health Network, Toronto, ON, Canada, ⁵University of California San Francisco, Department of Medicine/Rheumatology, San Francisco, CA, ⁶UCB Pharma, Monheim am Rhein, Germany, ⁷UCB Pharma, Slough, United Kingdom, ⁸UCB Pharma, Atlanta, GA, ⁹Radboud University Medical Centre, Department of Rheumatology, Nijmegen, Netherlands, ¹⁰University of California San Francisco, Department of Medicine, Division of Rheumatology, San Francisco, CA

Background/Purpose: Acute anterior uveitis (AAU) is the most common extra-musculoskeletal manifestation in axial spondyloarthritis (axSpA), affecting more than a third of patients. However, long-term interventional placebo-controlled studies are lacking due to ethical challenges. This study aimed to evaluate anterior uveitis flares rate in patients with axSpA who are at high risk of recurrent uveitis when treated with the PEGylated Fc-free TNF inhibitor certolizumab pegol (CZP) compared with standard non-biologic care.

Methods: In the C-VIEW study (NCT03020992), CZP was administered to patients with a high risk of uveitis flares (i.e., those with active axSpA, human leukocyte antigen-B27 [HLA-B27] positivity, and a history of recurrent AAU [≥2 AAU flares in total; ≥1 in the year prior to baseline]). This was an open-label, multicenter study where patients received CZP for 96 weeks; data up to Week 48 were used in the present analysis. The number of AAU flares in C-VIEW were compared to those seen in matched high-risk patients with non-biologic standard care from two North American axSpA centers who were followed up for 48 weeks. Inverse probability weighting (IPW) was performed to adjust for potential confounders, followed by Poisson regression, adjusted for follow-up time, to test the effect of treatment with CZP.

Results: A total of 89 patients received CZP and completed the C-VIEW study, while 66 bio-naïve patients (40 from the University of California, San Francisco and 26 from the University of Toronto) qualified as comparator with no exposure to biologic therapy during the 48-week follow-up period. All patients were HLA-B27 positive and had at least one episode of AAU before the baseline visit. Symptom duration and baseline CRP levels were similar in the two groups. Following IPW, there were no statistically significant differences in mean BASDAI and distribution of ASDAS disease activity states at baseline between the CZP treatment and comparator groups. Conventional synthetic DMARD use was similar between groups at baseline and during follow-up. The mean number of AAU flares (mean ± standard deviation) was significantly lower (p< 0.001) with CZP (0.42±0.81) than in the matched comparator population (1.3±1.47). In the final model after IPW, there was an 87% reduction in AAU flares (p≤0.001) associated with CZP treatment (Table).

Conclusion: This matched control study supports the benefit of CZP over standard non-biologic treatment in reducing anterior uveitis flares among high-risk patients with axSpA, highlighting its potential as a promising therapeutic option in managing this debilitating ocular manifestation in axSpA.




N. Haroon: AbbVie, 2, Eli Lilly, 2, Janssen, 2, Novartis, 2, UCB Pharma, 2; Z. Baskurt: None; T. Chim: None; R. Inman: AbbVie, 2, Eli Lilly, 2, Janssen, 2, Novartis, 2, Sandoz, 2; D. Paez: None; T. Kumke: UCB Pharma, 3, 11; R. Tham: UCB Pharma, 2, 3; M. Kim: UCB Pharma, 3, 11; I. van der Horst-Bruinsma: AbbVie, 2, 5, 12, Fees for lectures, BMS, 12, Fees for lectures, Eli Lilly, 2, MSD, 2, 5, 12, Fees for lectures, Novartis, 2, Pfizer, 5, UCB Pharma, 2, 5; L. Gensler: AbbVie, 2, Acelyrin, 2, Eli Lilly, 2, Fresenius Kabi, 2, Janssen, 2, Novartis, 2, 5, Pfizer, 2, UCB Pharma, 2, 5.